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Please reference the contract number on each page of all forms and any accompanying correspondence.
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Form Search Results

Select All
NameDescriptionTransaction TypeForm NumberStates
Accelerated Benefit Claim
 Complete to file an accelerated benefit claim. Claims NZ1361 12/18 NY
Accelerated Benefit Claim
 Complete to file an accelerated benefit claim. Claims Z1361 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Activation of Lifetime Income Benefit Request
 Use this form to activate a Lifetime Income Benefit. Other Transactions X4391 03/18 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Additional Premium for Perspective, Perspective II, Perspective Advisory, Focus, L Series and Rewards
 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6243 08/18 NY
Additional Premium for Perspective Advisors II
 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6245 08/18 NY
Additional Premium for Perspective Advisory II
 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6260 08/18 NY
Additional Premium for Perspective Advisory II and Jackson Private Wealth
 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits V6260 08/18 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Affidavit of LOST POLICY
 Use this form when a policy/contract is lost. Other Transactions N2028 04/15 NY
Affidavit of LOST POLICY
 Use this form when a policy/contract is lost. Other Transactions X2028 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Annuity Direct Deposit Request
 Use to set up or change bank information for direct deposit into client's bank account. Withdrawal, Payments & Deposits X1091 07/17 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Email Blank Form

Before investing, investors should carefully consider the investment objectives, risks, charges and expenses of the variable insurance product, including its underlying investment options. The current prospectus (or for the variable insurance products the contract prospectus and underlying fund prospectuses, which are contained in the same document) provides this and other important information. Please contact your representative or the Company to obtain the prospectus(es). Please read the prospectus(es) carefully before investing or sending money.

Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

• Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value •
• Not a deposit • Not insured by any federal agency •

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CMC17302 07/17

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Jackson National Life Insurance Company
1 Corporate Way
Lansing, MI 48951